Symptomatic Cough

Clinical Considerations
➤ General comments
– Coughing clears foreign particles and accumulated mucus from the respiratory passages.
– Coughing is a response to foreign particles caused by stimulation of neuroreceptors located on the larynx and esophageal bifurcation at the opening of the stem bronchi. The stimulus is usually mechanical, but sometimes also chemical or thermal in nature. The cough reflex travels through the afferent nerve fibers to the cough center of the medulla oblongata. Additional cough receptors are located in the bronchi, alveoli, and throat. A smaller number of receptors can be found in the nose and paranasal sinuses. Connected to the cough center are receptors in the auditory canal, esophagus, and stomach. Coughing is induced when these receptors are stimulated.
– Coughing for reasons other than to eject mucous secretions and foreign particles places unnecessary strain on the respiratory tract and should therefore be treated. Expectoration should be boosted through appropriate measures.
– If the cough becomes chronic, a thorough work-up should be performed to determine the cause and to initiate the proper treatment measures. Apart from lung and heart disease, other common causes include medications, such as ACE inhibitors, and environmental factors, such as irritant gases, cigarette smoke, and solvents.

➤ Herbal and general treatment measures
– Herbal remedies that quiet coughing (antitussives) or promote the ejection of mucus (expectorants) are delivered either by inhalation or orally.
– Herbal antitussives with central effects: The essential oil in eucalyptus leaves (cineol) and licorice root may have central effects.
– Herbal antitussives with peripheral effects reduce the sensitivity of cough receptors in the mucous membranes of the mouth and throat as well as in the esophagus and stomach.
– Anticoughing teas can help to liquefy thick mucous secretions. The secretolytic and expectorant actions of certain essential oils develops more effectively when the preparations are inhaled or taken in extract form. Saponincontaining herbs, on the other hand, should be administered by mouth since they work by stimulating the sensitive fibers of the gastric mucosa. The reflex stimulus is then passed on to the bronchial mucosa.
– Some herbal remedies have an additional anti-inflammatory effect (e. g., licorice root and sundew herb) or bronchospasmolytic effect (e. g., sundew herb, peppermint oil, and licorice root).

➤ Clinical value of herbal medicine
– Herbal remedies that liquefy the mucus have antitussive efficacy.
– All the specified herbal preparations are used for symptomatic treatment of coughs.

Recommended Herbal Remedies (Overview)
Demulcents
– Action: Reduction of coughing. The active constituents in some herbal demulcents (e. g., marshmallow root, ribwort plantain herb, Iceland moss) are transported by the mucus to the receptors in the mucous membranes of the mouth and throat. Those of others (e. g., naphthoquinone derivatives in sundew herb) take effect in the bronchial mucosa. Iceland moss contains bitter principles that additionally stimulate the production of saliva and digestive juices, thereby triggering a swallowing reflex that decreases the cough reflex.

• Antitussives
• Secretolytics and expectorants
• Antispasmodics
• Antiphlogistics

Range of Applications in Unspecific Dry Cough
➤ General comments
– Symptomatic treatment is justifiable if the cause of coughing cannot be identified or if the environmental factors causing the coughing cannot be eliminated. Herbal remedies with primarily antitussive and anti-inflammatory effects should be used.
– Aromatic oils such as anise oil, eucalyptus oils, fennel oil, menthol, peppermint oil, and thyme oil are useful. When allowed to dissolve in the mouth, they not only have a pleasant taste but also stimulate the swallowing reflex, which can be further enhanced by adding sugar or other sweeteners.

• Demulcents
• Antitussives
• Antiphlogistics

➤ Tea Rx: Althaeae radix 25.0, Foeniculi fructus 10.0, Lichen islandicus 10.0, Plantaginis lanceolatae herba 15.0, Liquiritiae radix 10.0, Thymi herba 30.0. Steep 1 tablespoon in 1 cup of boiled water. Sweeten and drink the fresh tea slowly and as hot as tolerable. Take 1 cup, several times a day.
➤ Dosage and administration: Commercial preparations (e. g., capsules, cough drops, lozenges, cough syrup) should be taken several times a day, as directed on the product label.
➤ Clinical value: For adjunctive treatment.
➤ Differential diagnosis: Chronic bronchitis.

Range of Applications in Bronchial Asthma
➤ Preliminary remarks
– The chronic inflammatory process associated with bronchial asthma is controlled by T-helper cells and effector cells involved in the inflammatory response. Eosinophil granulocytes and other cells are typically found in inflamed bronchial tissues and bronchoalveolar fluids.
– The main goals of therapy are to reduce inflammation and eliminate bronchospasms.

➤ Recommended herbal preparations: Eucalyptus oil in various forms
– Eucalyptus oil is often used in steam inhalers, or as a rub. Small amounts can be found in cough lozenges or cough syrups.
– Eucalyptus oil is is only rarely availaible in capsule or tablet form in the United States and is little used in these forms.
– Clinical value: For adjunctive treatment. A cortisone-reducing effect has also been reported.
Warning: Asthma patients are often allergic to essential oils.

Posted in: Respiratory Disease Natural Remedies